The influence of government ideology on the rate of e-waste recycling in the European Union countries

This study examines the impact of government ideology on e-waste recycling in 30 European countries from 2008 to 2018. This study seeks to enhance the e-waste recycling literature by introducing a novel determinant, examining the unexplored relationship between government ideology and e-waste recycling rates in European countries, thus addressing a substantial research gap. Utilizing panel quantile regression on an unbalanced dataset, the findings revealed that the increased influence of right-wing parties in government was associated with lower e-waste recycling rates. Conversely, greater influence of left-wing or center-wing parties was correlated with higher recycling rates across all quantiles analyzed. The estimation results remain robust when different indicators of government ideology were employed. Overall, the study underscores the importance of political ideology in shaping e-waste recycling policies and environmental sustainability efforts. It emphasizes that effective policies should align with the political commitment of the governing body.

Transcranial direct current stimulation of the right temporoparietal junction facilitates hippocampal spatial learning in Alzheimer's disease and mild cognitive impairment

OBJECTIVE

Spatial memory deficits are an early symptom in Alzheimer's disease (AD), reflecting the neurodegenerative processes in the neuronal navigation network such as in hippocampal and parietal cortical areas. As no effective treatment options are available, neuromodulatory interventions are increasingly evaluated. Against this backdrop, we investigated the neuromodulatory effect of anodal transcranial direct current stimulation (tDCS) on hippocampal place learning in patients with AD or mild cognitive impairment (MCI).

METHODS

In this randomized, double-blind, sham-controlled study with a cross-over design anodal tDCS of the right temporoparietal junction (2 mA for 20 min) was applied to 20 patients diagnosed with AD or MCI and in 22 healthy controls while they performed a virtual navigation paradigm testing hippocampal place learning.

RESULTS

We show an improved recall performance of hippocampal place learning after anodal tDCS in the patient group compared to sham stimulation but not in the control group.

CONCLUSIONS

These results suggest that tDCS can facilitate spatial memory consolidation via stimulating the parietal-hippocampal navigation network in AD and MCI patients.

SIGNIFICANCE

Our findings suggest that tDCS of the temporoparietal junction may restore spatial navigation and memory deficits in patients with AD and MCI.

AB0355 THE DIFFERENCES BETWEEN THE FIRST PREFERRED BIOLOGICAL DMARD AND THE DRUG SURVIVAL IN GERIATRIC AND YOUNGER ADULT POPULATION WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS: TREASURE REAL-LIFE DATA

Background

Inflammatory musculoskeletal diseases are frequent in the elderly population, and this number is expected to increase significantly near future. The exclusion of older adults from the studies due to their age and comorbidities causes insufficient data about this population. Insufficient data cause clinicians to have difficulties using and selecting biological therapy in the elderly patient group. In real life, physicians’ approaches to the selection and use of biological disease modifying anti-rheumatic drugs (DMARDs) in the geriatric population with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have not been well studied.

Objectives

To compare the clinicians’ first choice of biological DMARDs in elderly and younger RA and PsA patients and investigate the drug survival of first biological DMARDs in both populations.

Methods

The traditional chronological age for the human to be classified in the geriatric population is ≥ 65 years (1). The TReasure web-based registry, created in 2017, is a multicenter observational cohort established to collect data on RA and spondyloarthritis (SpA) patients from the participating 17 rheumatology centers in different regions of Turkey. Physicians’ first choice biological and targeted synthetic DMARDs in younger and elderly patients with RA and PsA was evaluated using the descriptive statistical method. The survival of the first b/tsDMARDs was assessed using the Kaplan-Meier method.

Results

3136 RA and 738 PsA patients were evaluated. 12% of 3136 patients with RA were in the geriatric population. In patients with RA, the first choice of biologic DMARDs was adalimumab (20.6%), followed by etanercept (19.9%), and tofacitinib (13.6%) in patients < 65 years of age, while rituximab (24%) was the first choice in patients ≥ 65 years, tofacitinib (20.9%) in the second place and etanercept (13%) in the third. Of 738 PsA patients, 3% were over 65 years. Adalimumab (41.1%) was the first choice of <65 years of age, etanercept (17.6%) was the second choice, and infliximab (15.5%) was the third choice, while adalimumab (28.6%) was the first choice in patients ≥ 65 years followed by etanercept (17.9%) and certolizumab (17.9%). In RA group, drug survival was significantly higher in patients ≥ 65 years (estimated median drug survival; <65 age: 37.5 (34.1-41.1) months vs ≥65 age: 53.5 (24.9-82.2) months; log-rank p=0,016) (Figure 1). In PsA group, drug survival was significantly higher in patients < 65 years (estimated median drug survival; <65 age: 31.2 (26.4-36.1) months vs ≥65 age: 9.1 (0.4-17.7) months; log-rank p<0,001) (Figure 1).

Figure 1.

Comparison of first bDMARD retention rates between <65 years and ≥ 65 years. A: In rheumatoid arthritis patients, B: In psoriatic arthritis patients

Conclusion

With these findings, it is thought that in Turkey, the limited socioeconomic support in the geriatric patients has led physicians to prescribe treatments such as rituximab, which are administered in the hospital under the supervision of a physician, are relatively preferred in malignancies, and are considered to be relatively less risky in terms of tuberculosis. Adalimumab and etanercept were chosen in the first two lines in both geriatric and young populations in the patient group with PsA. While the drug survival was significantly higher in patients with RA geriatric age group than the younger group, in PsA in which tumor necrosis factor-alpha (TNF-α) inhibitors were chosen as initial therapy in both age groups was lower in the geriatric population.

References

[1]Kotsani et al. JCM 2021. https://doi.org/10.3390/jcm10143018

Disclosure of Interests

None declared

AB0774 Paradoxical reactions, especially psoriasis in rheumatology patients receiving biologic therapy from the Treasure database: a 5-year follow-up study

Background

Biologic agents have altered our ability to treat chronic inflammatory diseases effectively. Although paradoxical reactions (PRs) were initially described with TNF-α inhibitors, they have been reported with newly developed biologic agents or classes too (1). Due to the potential consequences of PRs, it is critical to identify and treat these drug class side effects as soon as possible.

Objectives

The aim of this study was to characterize PRs, especially psoriasis, in a large cohort of patients treated with biologic agents and to investigate their clinical implications.

Methods

TReasure database, which was launched in 2017, is a web-based prospective observational cohort comprised of patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) from 17 centers located throughout Turkey. Characteristics of patients with PRs and clinicians’ treatment approaches and outcomes were evaluated using descriptive statistics.

Results

3147 RA and 6071 SpA patients were evaluated. 139 (1.5%) patients (40 (28.8%) with RA and 99 (71.29%) with SpA) developed a PRs (Table 1). The rate of paradoxical psoriasis was 90.6% and 9.7% of the patients had a family history of psoriasis. Females constituted 64% of the patients. The mean age was 46±12 years and the disease duration were 146±92 months. Mean time interval between the PRs and diagnosis was 99,6±86 months, whereas median 12 (1-132) months between the PRs and the biological agent. Adalimumab (30.9 %), etanercept (20.1 %), and infliximab (18.7 %) were the three most frequently used agents during the PRs. However, 8.6% of the patients developed PRs with non-TNF agents. Only seven patients (5.1%) who had PRs discontinued the drug, while 28 patients (20.6%) continued to receive the agent that caused the PRs. Majority of patients were switched to other TNF-α inhibitors (48.5%) and non-TNF agents (25.7%). When we limited our analysis to paradoxical psoriasis patients, we observed complete remission in 43.5% of patients and progression in only six (4.7 %) of patients. (Figure 1).

Table 1.

Characteristics of RA and SpA patients who developed paradoxical reactions

NPatients (N, %)Paradoxical reactions (PRs)139  Psoriasis126 (90.6%)  Uveitis6 (4.3%)  Sarcoidosis2 (1.4%)  IBD1 (0.7%) Other*4 (4.3%)Primary disease139  RA40 (28.8%)  SpA99 (71.29%)Time interval between PRs-diagnosis of RA/SpA (months)12499,6±86† 72 (3-420) ††Time interval between PRs-biological onset (months)12622±25† 12 (1-132) ††BMI, kg/m212328±5† 27,8 (17,3-49,7) ††Smokers (Current/ex)13161 (46.6%) / 10 (8.5%)Biological agents used during PRs139  TNF-α inhibitor used**127 (91.3%)  Secukinumab2 (1.4%)  Abatacept6 (4.3%)  Rituximab4 (2.9%)Biological agents used after PRs101  Etanercept31 (22.8%)  Adalimumab15 (11%)  Secukinumab12 (8.8%)  Other***43 (57.5%)

PRs: Paradoxical reactions IBD: Inflammatory bowel disease. *Drug-induced lupus:3 Vasculitis:1. ** Adalimumab: 43 (30.9%), Etanercept: 28 (20.1%), Infliximab: 26 (18.7%), Certolizumab: 20 (14.4%), Golimumab: 10 (7.2%). *** Certolizumab: 9 (6.6%), Tofacitinib: 9 (6.6%), Infliximab: 7 (5.1%), Tocilizumab: 5 (3.7%), Golimumab: 4 (2.9%), Ustekinumab: 4 (2.9%), Rituximab:3 (2.2%), Abatacept: 1 (0.7%), Anakinra: 1 (0.7%). † mean ± standard deviation. †† median (min-max)

Conclusion

Clinicians should be aware that PRs may develop with biologic agents other than TNF-α inhibitors. Additionally, it is important to keep in mind that the development time of PRs could be variable. The mechanism(s) behind PRs remain unknown, and there is no currently available diagnostic or therapeutic protocol (2). The decision whether to continue or discontinue biologic agents should be individualized. We found that the majority of patients can be managed without discontinuing biologic agents. Finally, we believe that the experience of our large cohort can help physicians in clinical practice where sufficient protocol is lacking.

References

[1]Lluís Puig. Curr Probl Dermatol. 2018; 53:49-63.

[2]Michael J Murphy. J Am Acad Dermatol. S0190-9622(20)33154-6.

Disclosure of Interests

None declared

POS1008 FACTORS ASSOCIATED WITH HIP INVOLVEMENT AND ITS IMPACT ON TREATMENT DECISION IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS; TREASURE EXPERIENCE

Background

Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting sacroiliac joints, spine and peripheral joints. In addition to spinal and peripheral manifestations, root joints (hip or sholder) involvement may also develop. Hip involvement is reported 24-36% in patients with Ankylosing Spondylitis (AS) by clinical evaluation of the rheumatologists. However, there is limited data regarding the factors related with the presence of hip involvement and treatment preference in patients with axSpA.

Objectives

The aim of this study was to evaluate the factors/covariates associated with the hip involvement and its impact on the treatment preferences in patients with axSpA patients who initiated their first biologic therapy.

Methods

In total, 1600 axSpA patients who initiated his/her first biologic were included in the study. The data for the current study was obtained from the TReasure web-based registry. Baseline demographics and disease related characteristics were collected. Characteristics and treatment preference of patients with and without hip involvement were compared. The factors/covariates associated with the presence of hip involvement were evaluated by regression analysis.

Results

Hip involvement was reported in 375 patients (23.4%). Patients with hip involvement were more common male patients in addition they had lower education level, lower BMI and more frequent HLA-B27 positivity as well as longer disease duration. Hip involvement was more frequent in patients with r-axSpA than patients with nr-axSpA. We found lower percentages of peripheral arthritis, enthesitis and dactylitis, higher BASFI or ASDAS-CRP scores, higher serum CRP levels and ESR values in patients with hip involvement. Moreover, patients with hip involvement had less frequently SpA-related family history (Table 1). When we analyzed patients according to age at diagnosis (≥ 16 years, <16 years) we found that patients with hip involvement were more common in juvenile onset axSpA group. In multivariate analysis, we found that lower education level (OR:2.029, 95%CI:[1.461-2.817]; p<0.001), diagnosis (r-axSpA) (OR:0.532, 95%CI:[0.337-0.839]; p=0.007) longer disease duration (OR:1.002, 95%CI:[1.001-1.004]; p=0.002), lower percentages of enthesitis (OR:0.405, 95%CI:[0.283-0.579]; p<0.001), higher BASFI scores (OR:1.086, 95%CI:[1.025-1.151]; p=0.005) and serum CRP levels (OR:1.005, 95%CI:[1.001-1.010]; p=0.019) absence of SpA family history (OR:0.713, 95%CI:[0.528]; p=0.027) were associated with hip involvement.

Table 1.

Characteristics of patients with axSpA

All patients (n=1600)Hip involvement (+) (n=375)Hip involvement (-) (n=1225)P*Juvenile (<16 years) onset, n(%)30 (1.9)12 (3.2)18 (1.5)0.031Male sex, n(%)940 (58.8)255 (68)685 (55.9)<0.001HLA-B27 positivity, n(%)605 (55)178 (62.7)427 (52.3)0.002BMI, kg/m2mean (SD)27.2 (5.2)26.7 (5.0)27.4 (5.2)0.023Education duration (≤12 years), n (%)1014 (65.9)263 (71.3)751 (64.2)0.013mNY positivity, n(%)1276 (79.8)338 (90.1)938 (76.6)<0.001Disease duration (month) median (IQR 25-75)82 (36-151)111 (52-200)74.5 (32-139)<0.001SPA-related family history, n (%)544 (34)110 (29.3)434 (35.4)0.029BASFI, mean (SD)3.9 (2.5)4.3 (2.1)3.8 (2.7)0.007ASDAS-CRP, mean (SD)3.1 (1.5)3.7 (1.4)2.9 (1.5)<0.001CRP (mg/dl), median (IQR 25-75)8.6 (3-21)12.0 (4.0-27.9)7.6 (2.5-19)<0.001

When we compared the treatment patterns of axSpA patients with and without hip involvement, we found that the percentages of NSAID as well as csDMARD use were similar in groups. However, the percentages of patients who were prescribed etanercept were higher in axSpA patients with hip involvement (p<0.001).

Conclusion

In addition to inflammation and function, hip involvement seems to be related with diagnosis (r-axSpA), education level and absence of SpA family history. Moreover, enthesitis may not accompany hip involvement.

Disclosure of Interests

None declared

AB0766 Biologic Drug Preferences of Turkish Rheumatologists in Spondiloartropathy Patients with Advanced Chronic Renal Disease

Background

Biological therapies are the main treatment options for patients with active spondyloarthropathy (SpA) who do not respond to nonsteroidal anti-inflammatory drugs or conventional synthetic disease-modifying drugs. Kidney diseases are not a contraindication to biologic therapies. However, there are some safety concerns for these drugs for patients with advanced chronic kidney disease. De novo infection or recurrence of infections are the main challenges in patients with multiple comorbidities during biologic treatments. Neverthless, physicans should initiate these treatments in active and resistant diseases.

Objectives

Here, we evaluated which biologic therapies clinicians’ first option to initiate in SpA patients with advanced chronic kidney disease (CRD).

Methods

Total 140 patients of TREASURE database who fullfield axial and/or peripheral ASAS SpA criteria with glomerular filtration rate < 60 ml/dk (stage 3,4 or 5 CRD according to The National Kidney Foundation classification) were included to the study. Renal stages of the patients were evaluated when biologic therapy was initiated. Five anti-TNF (adalimumab, certolizumab, etanercept, golimumab, infliximab) and an interleukin-17A blocker (secukinumab) were on the market during the study. We evaluated physicans’ first choice for biologic therapy for patients with stage 3,4 and 5 CRD respectively.

Results

More than two thirds of the patients had stage 3 CRD. Anti-TNF drugs were the first choice of biologic treatment in the patients with advanced CRD. Etanercept was started at most to the patients in general, in stage 3 and in stage 5 CRD groups. However, adalimumab was the first choise in stage 4 CRD. Both etanercept and adalimumab were the first drug of choise in three fourth of the stage 4 and stage 5 patients. All two patients on Il-17A blocker had stage 3 CRD (Table 1).

Table 1.

Drug of choise in the SpA patients with advanced chronic renal diseases

NTotal n (%)NStage 3 n (%)NStage 4 n (%)NStage 5 n (%)Adalimumab14044 (31.4)10830 (27.8)209 (45.0)125 (41.6)Etanersept52 (37.1)41 (38.0)5 (25.0)6 (50.0)Golimumab9 (6.0)7 (6.5)2 (10.0)0 (0)Infliksimab28 (20.0)23 (21.3)4 (20.0)1 (8.4)Secukinumab3 (2.1)3 (2.8)0 (0)0 (0)Sertolizumab4 (2.8)4 (3.7)0 (0)0 (0)

Conclusion

We show that rheumatologists in the TREASURE group prefer to initiate anti-TNF drugs first in all advanced CRD stages. Etanercept was the first choice in these patients.

References

[1]Sieper J, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009 Jun;68 Suppl 2:ii1-44. doi: 10.1136/ard.2008.104018. PMID: 19433414.

[2]Antoni C, Braun J. Side effects of anti-TNF therapy: current knowledge. Clin Exp Rheumatol. 2002 Nov-Dec;20(6 Suppl 28):S152-7. PMID: 12463468.

[3]Kalyoncu U, et al. Methodology of a new inflammatory arthritis registry: TReasure. Turk J Med Sci. 2018 Aug 16;48(4):856-861. doi: 10.3906/sag-1807-200. PMID: 30119164.

Disclosure of Interests

None declared

O51: ARTIFICIAL INTELLIGENCE UTILIZING RECURRENT NEURAL NETWORKS TO CONTINUOUSLY MONITOR COMPOSITES OF SURGICAL EXPERTISE

Introduction

Many surgical adverse events occur secondary to technical errors related to poor bimanual skills, fatigue and lack of the required expertise. We developed AI algorithms to continuously assess surgical bimanual technical performance during virtual reality simulated surgical tasks. To our knowledge, this is the first attempt in surgery to train AI algorithms to continuously monitor and evaluate bimanual skills comprehensively.

Method

Fifty individuals from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed two virtual reality simulated surgical tasks with haptic feedback: a subpial tumor resection 5 times and a complex, realistically simulated brain tumor operation once. Each task required complete tumor removal while minimizing bleeding and damage to surrounding tissues using a simulated ultrasonic aspirator and a bipolar. A recurrent neural network continually tracked individual bimanual performance utilizing 16 performance metrics generated every 0.2 seconds.

Result

The recurrent neural network algorithm was successfully trained using neurosurgeons and medical students' data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm outlined and monitored technical skills every 0.2 second continuously organizing performance of each surgical task into three levels: ‘excellent’, ‘average’ and ‘poor’. The percentage time spent on each level was calculated and significant differences found between all four groups for ‘excellent’ and ‘poor’ levels.

Conclusion

AI-powered surgical simulators provide an advanced assessment and training tool. AI's ability to continuous assess bimanual technical skills during surgery may further define the composites necessary to train surgical expertise.

Abbrev

AI: artificial intelligence

Take-home message

By advanced artificial intelligence algorithms surgeon's bi-manual technical skills can be assessed continuously, time periods of poor performance which increase the possibility of errors in performance can be identified.

The Systematic Effect of Mesenchymal Stem Cell Therapy in Critical COVID-19 Patients: A Prospective Double Controlled Trial

The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-β, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

Mesenchymal stem cells treatment in COVID-19 patient with multi-organ involvement

The aim of this study is to evaluate the therapeutic effect of mesenchymal stem cells (MSCs) in a severe case of brain and multiple organ involvement in a patient with COVID-19. Here, a 51-year-old male patient with multi-organ involvement due to COVID-19 infection and developing cardiac arrest is presented. MSCs were transplanted to the patient four times systematically and once intrathecally. As a result, the application of MSCs has been found to have a healing effect on organs in this patient with severe COVID-19 infection. In addition, transplantation of MSCs both systematically and intrathecally is considered to be effective in the treatment of the central nervous system (Tab. 2, Fig. 2, Ref. 24). Keywords: mesenchymal stem cell, COVID-19, organ involvement.

Lycopene has a protective effect on septic shock‑induced cardiac injury in rats

OBJECTIVE

The aim of the present study is to investigate the cardioprotective effect of lycopene, known for its antioxidant and anti-inflammatory effect, in a rat sepsis model induced by lypopolysaccharide (LPS).

METHODS

The oxidative stress parameters, antioxidant parameters and cytokine levels with or without lycopene treatment in LPS‑induced septic rats as well as in controls were measured in serum and tissue. Histologic examinations of the cardiac tissues were also performed. The Kruskal-Wallis and the Bonferroni-adjusted Mann-Whitney U Test was used for analysis. A p value < 0.05 was considered significant.

RESULTS

The data of this study showed that lycopene pretreatment reduced the oxidative stres parametersand , proinflammatory cytokines as well as increased the antoxidant enzyme activities in both serum and cardiac tissues in LPS‑induced septic rats.. Moreover, hyperaemia and haemorrhage in the epicardium, myocardium and endocardium were lower in the lycopene pretreated group as compared to the LPS alone group.

CONCLUSION

These results suggest that lycopene could be beneficial for the prevention of cardiac injury caused by sepsis through reducing the cytokine levels and oxidative stress parameters (Tab. 4, Fig. 1, Ref. 35).

Assessment of paediatric Hashimoto's thyroiditis using superb microvascular imaging

AIM

To evaluate the role of superb microvascular imaging along with greyscale and Doppler imaging for thyroid gland evaluation in Hashimoto's thyroiditis (HT) versus control subjects.

MATERIALS AND METHODS

The study included 33 healthy volunteers with normal ultrasound and laboratory findings and 70 patients with HT based on laboratory and sonographic findings who were undergoing follow-up and receiving medical treatment. HT patients were classified based on the modification of the scheme proposed by Sostre and Reyes that incorporates the extent of hypoechoic foci or patchy infiltration as grade A (foci involving <50% of the gland) and B (foci involving >50% of the gland). Thyroid volume, mean resistive indices, peak-systolic and end-diastolic velocities based on Doppler imaging, and vascularity index via superb microvascular imaging were obtained using a Canon Aplio 500 ultrasound device using a linear 10-14 MHz transducer.

RESULTS

Patients with HT had significantly higher median thyroid volume and peak-systolic velocities (7.32 ml and 19 cm/s, respectively) compared to control subjects (4.62 ml and 16 cm/s, respectively). HT patients had significantly higher median vascularity index (VI; 13.5%) compared to control subjects (7.95%). A significant fair positive correlation with VI and anti-thyroglobulin antibody levels (r=0.356, p<0.05) and significant moderate positive correlation with VI and anti-thyroid peroxidase antibody levels (r=0.503, p<0.05) were found. In HT diagnosis, the optimal VI cut-off value was 10.58% with a sensitivity and specificity of 67.1% and 90%, respectively.

CONCLUSION

Superb microvascular imaging appears to allow assessment of subtle vascularity changes in early HT stages that cannot be detected by Doppler parameters. This technique demonstrates excellent visualization of the microvascular structures and quantitative assessment based on a novel parameter such as VI.

Coeliac trunk and common hepatic artery variations in children: an analysis with computed tomography angiography

BACKGROUND

Understanding the coeliac trunk (CeT) and hepatic artery anatomy is important not only in preventing iatrogenic injuries but also in planning surgical procedures in children. Therefore, the aim of this study is to analyse the prevalence of CeT and common hepatic artery (CHA) variations in the paediatric population.

MATERIALS AND METHODS

One hundred and seventy-four children who underwent abdominal multidetector computed tomography (MDCT) angiography, either because of trauma or liver transplantation, were analysed retrospectively. The patterns of CeT, CHA and their variant branches were revealed and compared with previous studies involving adults.

RESULTS

A total of 157 (90.2%) of the 174 patients had normal CeT anatomy, whereas 17 (9.8%) had variations. Five types of CeT variations were identified according to Song's classification in which 'hepatosplenic trunk + left gastric artery + superior mesenteric artery' was the most prevalent. One hundred-twelve (64.4%) of the 174 patients had normal CHA anatomy; however, 62 (35.6%) had variations. Six types of CHA variations were identified according to Michel's and Hiatt's classification. The most common was 'replaced left hepatic artery originating from left gastric artery'.

CONCLUSIONS

The prevalences of CeT and hepatic artery variations are high in children, as they are in older patients. Awareness of these variations is important in terms of avoiding iatrogenic injury and in promoting surgical procedure planning for liver transplantation or abdominal tumour surgery.

Expression of ADAMTS-7 in myocardial dystrophy associated with white muscle disease in lambs

The aim of the present study was to investigate the role of ADAMTS-7 gene in the pathogenesis of myocardial dystrophy associated with white muscle disease (WMD) in lambs. A total of 217 cardiac tissue samples from lambs with WMD were used in the study. Histopathological sections of the samples were stained with hematoxylin-eosin (HE) and examined using Western-blot, real-time PCR (RT-PCR) and immunohistochemistry for ADAMTS-7 gene expression, and the findings were statistically evaluated. Histopathological examinations revealed fibrosis associated with hyalinization, necrosis and granular calcifications in cardiomyocytes. Western blot and RT-PCR showed a statistically significant upregulation of ADAMTS-7 (p<0.05) (p<0.05). Immunohistochemical analyses showed that immunopositive cell numbers significantly high for ADAMTS-7 (p<0.05). The study has revealed that ADAMTS-7 gene is significantly expressed in myocardial dystrophy associated with WMD in addition to its role in the pathogenesis of this disease.

Does allograft size really matter in the long-term outcome of living donor kidney transplantation?

BACKGROUND

Increased allograft mass in living donor kidney transplantation has been recognized as a predictor factor of better short-term allograft function. We evaluated whether donor kidney volume adjusted for recipient body weight is associated with long-term allograft function in living donor kidney transplantation.

METHODS

We analyzed 67 living donors and their recipients who underwent transplantation between 2003 and 2007. Estimated glomerular filtration rate (eGFR) and serum creatinine levels at 1, 2, 3, 4, and 5 years post-transplantation were recorded for all recipients. Transplanted kidney volumes were measured using 3-D helical computed tomography scanning. A transplant kidney volume-recipient body weight (Vol/Wt) ratio was calculated for each donor-recipient pair. The subjects were divided into tertiles according to Vol/Wt ratios: low (<2.16), medium (2.16-2.88), and high (>2.88).

RESULTS

Vol/Wt ratio significantly correlated with recipient eGFR and serum creatinine levels at 1, 2, 3, and 4 years post-transplantation (r = .48, P < .0001; r = .46, P < .0001; r = .47, P < .0001; r = .26, P = .037, respectively, for eGFR; r = -.53, P < .0001; r = -.50, P < .0001; r = -.44, P < .0001; r = -.37, P = .003, respectively, for serum creatinine) but not at 5 years (r = .12, P = .406 for eGFR; r = -.21, P = .110 for serum creatinine). Whereas recipient eGFR increased significantly in a graded fashion among low to high Vol/Wt ratio groups during 1 to 3 years post-transplantation, there was no difference in eGFR values between Vol/Wt ratio groups at 4 and 5 years (P = .21 and .71, respectively).

CONCLUSION

Vol/Wt ratio is not associated with long-term allograft function in living donor kidney transplantation.

Endothelial dysfunction in renal transplant recipients: role of vitamin D and fibroblast growth factor-23

BACKGROUND

Endothelial dysfunction can be detected at early stages of chronic kidney disease. Although endothelial functions improve after successful renal transplantation, renal transplant recipients have still worse endothelial functions compared to healthy subjects. Vitamin D deficiency and high fibroblast growth factor-23 (FGF-23) levels may have a role on endothelial dysfunction in chronic kidney disease patients. The aim of this study is to investigate the association between endothelial functions, vitamin D, and FGF-23 levels in renal transplant recipients.

METHODS

One hundred nine renal transplant recipients (71 male, 38 female) underwent brachial flow-mediated dilatation (FMD), serum 25-OH vitamin D, and FGF-23 level measurements. Vitamin D and FGF-23 levels were compared between patients with normal and abnormal endothelial functions. Correlations between FMD, vitamin D, and FGF-23 were also investigated.

RESULTS

Endothelial functions were abnormal in 72.5% of the patients. Prevalence of vitamin D deficiency was 80.7%. Vitamin D levels were significantly lower in patients with endothelial dysfunction compared to patients with normal endothelial functions (12.6 ± 6.6 μg/L vs 17.3 ± 10.0 μg/L respectively, P = .02). FGF-23 levels were not different between the two groups. 25-OH vitamin D levels had a significant positive correlation with amount of FMD (r = 0.218 and P = .02) and were an independent predictor of FMD after adjusting for potential confounding factors including age, transplantation duration, body mass index, mean blood pressure, glomerular filtration rate, proteinuria, hemoglobin, and FGF-23 in multivariate regression analysis (beta = 0.194, P = .04). FGF-23 levels were not predictive of FMD in this model (beta: -0.125, P = .197) CONCLUSION: Vitamin D deficiency is associated with endothelial dysfunction in renal transplant recipients. Further clinical and experimental studies are necessary to define a causal relationship between the parameters, discover the potential mechanisms, and observe the effect of vitamin D replacement on endothelial functions in renal transplant recipients.

Association between urinary angiotensinogen, hypertension and proteinuria in pregnant women with preeclampsia

INTRODUCTION

Preeclampsia is a life-threatening disorder of pregnancy. The pathogenic mechanisms of preeclampsia remain uncertain. The aim of this study is to investigate the relation between urinary angiotensinogen (UAGT) levels, an indicator of local renin-angiotensin system (RAS) activity in the kidney, and blood pressure and urinary protein excretion in preeclampsia.

MATERIALS AND METHODS

For this study, 90 women aged between 20-39 years were recruited. Spot urine samples were collected to measure urinary angiotensinogen/creatinine ratio (UAGT/UCre). Log(UAGT/UCre) was compared in pregnancies with and without preeclampsia and non-pregnant controls. Factors affecting log(UAGT/UCre) in pregnancies were also investigated.

RESULTS

In all pregnancies log(UAGT/UCre) levels were significantly higher than in non-pregnant controls (0.58±0.19 vs. 0.33±0.14, respectively, p=0.002). However, log(UAGT/UCre) levels in pregnancies with preeclampsia were slightly lower than in normal pregnancies (0.52±0.18 vs. 0.64±0.19, respectively, p=0.012). Log(UAGT/UCre) levels were correlated positively with blood pressure and proteinuria in pregnancies with preeclampsia. However, log(UAGT/UCre) levels were not correlated with age, height, body weight, gestational age, body mass index, and serum creatinine.

CONCLUSION

This study showed that elevated local RAS activity in kidney was correlated with high blood pressure and proteinuria in preeclampsia. Local RAS activation in the kidneys may be one of the contributing factors in the development of preeclampsia.

Immunohistochemical characterization of perineal melanoma in Kilis goats

We describe the clinical, histopathological and immunohistochemical features of the malignant melanomas in the perineal regions of Kilis goats from Sanliurfa province in Turkey. We studied 13 female Kilis goats between 3 and 8 years old that were brought to Harran University Veterinary School, Department of Surgery, between 2002 and 2010. By macroscopic examination, the masses were determined to have elastic consistency, dark brown-black color, necrotic surfaces and ulceration. Microscopically, pleomorphic cells were observed under the basal layer and these advanced toward the dermis. These cells were polyhedral, round or spindle-shaped, anaplastic, and their cytoplasm contained varying amounts of dark brown-black pigments. Immunohistochemical staining was obtained with anti-melan A, vimentin and S100 antibodies.

Rare Cause of Cerebral Damage: Child with Heatstroke Found inside an Enclosed Vehicle

Many children suffer from preventable diseases. Heat stress is one of the neglected causes of mortality and morbidity. We report here the clinical features of a 3-year-old boy who suffered from near-fatal heatstroke in an enclosed car. He developed multiple organs failure, including neurological insult, acute renal failure, and disseminated intravascular coagulation. Although life-threatening complications were treated with supportive measures and conventional external cooling in the intensive care unit, neurological sequelae persisted. This type of heatstroke is almost always preventable. Similar to many other pediatric emergencies, it can be life-threatening and may result in severe untoward outcomes.

Predictive value of Doppler ultrasound in childhood pneumonia

This study aimed to determine the predictive value of intercostal and pulmonary artery Doppler flow patterns in the outcome of childhood pneumonia. Pneumonia was classified according to type of pleural effusion and the ultrasound features of consolidations. Doppler flow patterns of intercostal and pulmonary arteries were analysed and correlated with pneumonia type and hospital stay. Of 83 pneumonia cases, 55 were uncomplicated and 28 were complicated. Pleural effusion was present in 54 cases, with 29 non-septated and 25 septated cases. Patients with uncomplicated pneumonia did not have abnormal Doppler flow patterns, compared with 64% (18 of 28) of patients with complicated pneumonia. Doppler ultrasound patterns in childhood pneumonia were correlated with pneumonia type and may be predictive of pneumonia outcome.

Prevalence of hepatic pseudolesions around the falciform ligament in a paediatric population

This study investigated the prevalence and features of hepatic pseudolesions around the falciform ligament in 320 children undergoing contrast-enhanced abdominal multidetector computed tomography. Aberrant venous drainage was investigated using thin-section computed tomography images. Pseudolesions around the falciform ligament were detected in 63 patients (20%). The longest diameter was in the craniocaudal direction in 41 (65%) patients (lesions). An inferior vein of Sappey supplying the pseudolesions was seen in 11 patients (17%). Thirteen patients of the 63 patients (21%) with pseudolesions who had a history of extrahepatic malignancy were also examined by ultrasound; in two of the 13 patients the lesions were isoechoic and, in the remainding 11 patients, they were hyperechoic. It was concluded that hepatic pseudolesions around the falciform ligament occur frequently in the paediatric population on CT images. Detection of the longest diameter in the craniocaudal direction and the presence of an inferior vein of Sappey and fatty infiltration should be sufficient to exclude true lesions and make further evaluations unnecessary.

Screening for metastasis in primary breast cancer patients having four or more axillary lymph node involvement: is it really necessary?

PURPOSE

To evaluate the necessity and direct cost effectiveness of screening and staging procedures in breast cancer patients having ≥4 positive axillary lymph nodes and to identify further possible biopathological risk factors associated with increased risk of metastasis.

METHODS

We reviewed the demographic and clinicopathological data from the medical records of 1897 newly diagnosed breast cancer patients. Patients having ≥4 positive axillary lymph nodes after primary surgery for breast cancer and who had staging examinations for metastasis were eligible. The impact of staging procedures (thoracoabdominal CT, bone scan etc.) for detecting metastasis, decision of adjuvant treatment and direct costs were analyzed in 329 patients with operable breast cancer.

RESULTS

Thirty-five (10.6%) patients were found with metastasis at diagnosis. Seven (20.0%) among them had multiple metastases. Eighteen (51.4%) had lung, 17 (48.6%) bone, and 7 (20.0%) liver metastasis. Twenty-one (60.0%) patients needed further radiological investigation for metastasis confirmation. Treatment decision was changed in 27 (77.1%) patients. No statistically significant risk factor was identified among the metastatic patients by means of conventional demographic and biopathological parameters. The cost of screening was lower when compared to the cost of treatment without any screening procedure.

CONCLUSION

Since the conventional clinicopathological data seems not sufficient to define the risk of developing metastasis in breast cancer patients with ≥4 axillary lymph node involvement, all of them should undergo full staging examinations until new parameters based on genomic level are defined. Staging procedures need modification for high risk breast cancer patients.

Public Knowledge and Attitude toward Crimean Congo Hemorrhagic Fever in Tokat Turkey

BACKGROUND

The World health Organization (WHO) declares Crimean Congo hemorrhagic fever (CCHF) endemic in Turkey. Despite the magnitude of problem, no documented evidence exists in Turkey, which reveals the awareness and practices of the country's adult population regarding CCHF, its spread, symptoms, treatment, and prevention. This study was conducted to assess the level of knowledge, attitudes, and practices regarding CCHF in people visiting tertiary care hospital in Tokat, Turkey.

METHODS

This questionnaire based cross-sectional survey was conducted among patients' relatives or guardians who admitted pediatric outpatient clinics during May-July 2008. The questionnaire was composed of 25 questions.

RESULTS

A total of 1034 respondents participated in the survey. Sufficient knowledge about CCHF was not found in 28.9% of the sample. Literate individuals were relatively better informed about CCHF as compared to the illiterate people. Television and radio were considered as the most important and useful source of information on the disease.

CONCLUSION

We have found insufficient knowledge on CCHF in our population. It is thought to have no chance of success against a fatal disease such as CCHF, which has serious consequences, without the contribution of community. It is clear that there are important tasks for health, agriculture, and media sectors to improve public knowledge and awareness about CCHF.

Tumor markers in familial Mediterranean fever and their correlation with the frequency of attacks

OBJECTIVE

Serum levels of tumor markers can be elevated in several benign diseases affecting the serosal surfaces. Familial Mediterranean fever (FMF) is a genetic disease characterized by acute attacks of fever and inflammation of the serosal membranes. The aim of this study was to examine the levels of tumor markers in FMF patients and their correlation with the frequency of attacks.

METHODS

Serum levels of CA 125, CA 19-9, CA 15-3, CA 72-4, CEA, and AFP were measured by ELISA in 36 patients with a definitive diagnosis of FMF (21 males, 15 females, mean age 36.4+/-10.3 yrs) and in 19 healthy controls.

RESULTS

Serum levels of all tumor markers were normal in the controls. In FMF patients serum levels of CA 125, CA 19.9, CA 15.3, CEA and AFP were within normal ranges, whereas CA 72.4 was significantly higher than in the controls (p=0.001). Half of the FMF patients showed increased levels of CA 72.4; the mean level was lower in those in complete remission. However, no statistically significant correlation was found between FMF attacks and acute phase reactant levels.

CONCLUSION

With the exception of Ca 72.4, serum levels of tumor markers are not affected by changes in inflammatory cytokines levels during FMF attacks.

Volatile solvent abuse caused glomerulopathy and tubulopathy in street children

Substance misuse among street children is a significant problem in developing countries. Volatile substances are the most abused agents. According to case reports, chronic renal diseases are common among substance-abusing street children. In this study, we examined the renal findings of 42 volatile substance–abusing street children and compared them with results from 49 healthy children (control). The street children’s weight, height, and blood pressure were lower than the controls’ ( P < 0.05). However, their blood alkaline phosphatase and creatinine phosphokinase levels were higher ( P < 0.05), and total blood protein, creatinine, and phosphorus levels were lower than the controls’ ( P < 0.05). Furthermore, the street children’s glomerular filtration rates were within normal limits ( P < 0.05), their urinary N-acetyl-beta-glucosaminidase (NAG), β2-microglobulin, microalbumin, protein, calcium, phosphorus, sodium, potassium, and chloride excretions were higher, and tubular phosphate reabsorption were lower than the controls’ ( P < 0.05). Volatile substances have been charged with causing distal tubular disease, but increased urinary protein, NAG, β2-microglobulin, microalbumin, and electrolyte excretions also result from glomerular, proximal, and distal tubular influences. We believe that increased volatile substance products in the renal parenchyma are responsible for glomerular and tubular damage. Volatile substance–abusing street children should be examined for glomerular and proximal tubular function and distal tubular acidosis.

Relationship between myocardial performance index and aortic distensibility in patients with essential hypertension

We aimed to investigate the association between aortic distensibility (AD) and left ventricle myocardial performance index (MPI) in patients with newly diagnosed hypertension (HT). We studied 49 patients with HT and 24 healthy control subjects. AD was calculated from the echocardiographically derived ascending aorta diameters. The MPI was calculated from both conventional flow Doppler echocardiography and tissue Doppler echocardiography recordings. Conventional Doppler E/A and tissue Doppler derived Ea/Aa were determined for all the subjects. Aortic distensibility was lower, and both conventional and tissue Doppler MPI values were higher (p<0.001 for all) in patient group compared with control group. AD was correlated with systolic blood pressure (SBP) (beta=-0.436, p=0.037), Ea/Aa (beta=0.228, p=0.038) and tissue derived MPI (beta=-0.302, p=0.043) in multiple linear regression analysis. Aortic distensibility was independently related to tissue derived MPI and Ea/Aa besides SBP.